| Popis: |
Introduction: In our community up to 2016, treatment with direct-acting antivirals was limited to patients with advanced fibrosis, and from January 2017, treatment was allowed to all patients, regardless of their fibrosis stage. Objectives: To assess changes in the profile of patients treated, and their impact on th outcome. Methods: We collected clinical information, virological characteristics, type of therapy and Sustained Virological Response from patients treated between 2014-2016 (prioritised treatment) and 2017-June 2020 (universal access). Results: We treated 1148 patients until June 2020, 361 between 2014-2016 and 787 between 2017-June 2020. In both periods, the majority were male (although we see an increase in women in 2nd period, 35 vs 43%). The percentage of patients with fibrosis 3-4 was clearly higher in the first period (88.8), as expected due to the prioritisation policy, but in the 2nd period it still represents 30.6% of patients. Of these, 63.2 and 20.4% of patients had cirrhosis. We treated few patients with decompensated cirrhosis, most of them in the first period (10 vs. 2). Genotype 1, mainly 1b, was the most prevalent in both periods. Regarding treatment, 28.8% of patients in the first period had received some previous treatment (vs 7.8% in the 2nd period). In the first period ribavirin was routinely used (67.6% vs 11.7%), pan-genotypic treatments were used in only 14.1% of patients (vs. 75.2%) and treatments were longer (8 weeks: 0 vs. 44.7%, 12 weeks: 66.5 vs. 52.2%, 24 weeks: 32.7 vs. 2.7%). SVR rate was slightly superior in the second period (99.1 vs 96.1%). Conclusions: Despite having prioritised the treatment of patients with advanced fibrosis, these patients still represent one third of those subsequently treated. This should make us persevere in our efforts to identify patients with Hepatitis C. On the other hand, the advent of new, shorter duration pan-genotypic treatments has greatly simplified treatment and improved SVR rates. |
